Wednesday, September 24, 2014

Children can be trained to recognise emotions

Children can using training to spot crucial cues on someone's emotional state, new research from the University of Lincoln, UK, has show.

Children can learn to better recognise other people's emotions through games which emphasise the significance of the eyes and the mouth in conveying feelings, new research has shown.

The study by cognitive neuroscientists at the University of Lincoln, UK, suggests that simple training programmes could help children better understand which expressive facial features offer the most important cues to other people's emotional state.

It is hoped the findings, published in the peer reviewed science journal PLOS ONE, could lead to new or improved interventions for children and adults who have difficulty recognising emotional states in others.

Dr Petra Pollux, a cognitive neuroscientist from the University of Lincoln's School of Psychology, said: "How we recognise and process facial expressions plays a big part in our social interaction skills."

"We've all experienced walking into a room, looking around and immediately understanding that something has happened, and that's because we're reading the expressions on people's faces."

"This ability to understand and read facial expressions is a crucial skill in development and begins at quite an early age."

"Generally, when we look at faces, we look at the eyes and the mouth, but with a definite bias towards the eyes."

"We wanted to investigate if there was a correlation between which parts of the face the children looked at and their ability to correctly pick up on the emotional state of the person in the image."

During the study nine-year-old children were shown images which conveyed varying levels of intensity of emotional expressions, from a small smile to a big grin, and asked to match it with the correct emotion. If they answered incorrectly, they were alerted by a tone.

Children and adults were not given any instructions about eye-movements, but over the four sessions learned that focusing more on the eyes offered the crucial clues they needed.

The images used in the study were digitally manipulated and showed happy, sad or fearful expressions.

An adult's ability to recognise emotions was also assessed and compared with children's, and in both cases, special eye tracking equipment was used to monitor their gaze pattern and determine which features of the face, such as the eyes, nose or mouth, they focused on most.

Children looked less often and for a shorter duration at the eyes, and more often and for longer at the mouth compared with adults.

Training for both adults and children increased the amount of time spent looking at the eyes, although for adults this was only for faces which showed a sad expression.

Children, however, showed a significant increase in the amount of time spent focused on the eyes of all three expressions after training, leading to more correct answers.

The images used in the final session were also replaced by new faces, meaning their abilities translated to different people, researchers said.

Dr Pollux added: "It's really useful to know that the way a child scans a face plays an important role in recognising emotions. This research could be used to develop mobile phone apps which turn this kind of training into a game."

Researches now hope that the findings will inform training programmes for people in need of a better understanding of recognising facial expressions, such as those with autism or other cognitive development problems.

More information: Pollux PML, Hall S, Guo K (2014) "Facial Expression Training Optimised Viewing Strategy in Children and Adults." PLOS ONE 9(8): e105418. DOI: 10.1371/journal.pone.0105418

Tuesday, September 23, 2014

Beat synchronization in preschoolers aids learning and reading skills

A team of researchers with Northwestern University in the U.S. has found that an ability to synchronize with a beat may be an indication of how well preschoolers will later do when developing reading skills.

In their paper published in Proceedings of the National Academy of Sciences, the team describes a study they undertook that involved testing for beat synchronization and sound recognition in preschoolers and what they found as a result.

Devising a test for reading aptitude prior to teaching children to read, it is believed, would help children of all levels learn better.

If a teacher knew beforehand that a child was going to have a reading disability, for example, that child could be placed into a program developed specifically for their needs, hopefully offering a better long term outcome.

Likewise, children with an exceptional aptitude for reading could be put into an accelerated program to prevent boredom.

Unfortunately, there is no such test, thus parents and teachers are left to discover a child's reading abilities on their own.

In this new effort, the researchers devised a study to find out if beat synchronicity skills might be used as the basis for such a test.

Reading specialists have suspected that there is a link between beat synchronization and both language and reading ability, reading and speech are both timing based after all.

To better understand that link the researchers arranged to test preschool volunteers.

In the first test, 35 children were given a toy drum and asked to beat it in time with an adult beating on a similar drum.

Those that could do it well were described as synchronizers, those that could not, as nonsyncronizers.

The same group of children then had electrodes pasted to their scalps to measure brain waves, as the researchers watched monitors, the children listened to sounds the researchers played, such as "da" and "ba" with no other sound, and then with background noise.

In studying the data, the researchers found that the children dubbed synchronizers in the first part of the experiment processed the played sounds with greater precision than did the nonsyncronizers.

Further tests revealed that the synchronizers did better on overall language abilities than the nonsyncronizers, which suggests that it might be possible to use the same process to test children as young as infants for later reading ability.

The researchers plan to continue monitoring the same children in the study for five years to see if their testing method is viable.

More information: Beat synchronization predicts neural speech encoding and reading readiness in preschoolers, Kali Woodruff Carr, PNAS, DOI: 10.1073/pnas.1406219111

Monday, September 22, 2014

EEG Brainwave test could improve autism diagnosis and classification



A new study by researchers at Albert Einstein College of Medicine of Yeshiva University suggests that measuring how fast the brain responds to sights and sounds could help in objectively classifying people on the autism spectrum and may help diagnose the condition earlier.

The paper was published today in the online edition of the Journal of Autism and Developmental Disabilities.

The U.S. Centers for Disease Control and Prevention estimates that 1 in 68 children has been identified with an autism spectrum disorder (ASD).

The signs and symptoms of ASD vary significantly from person to person, ranging from mild social and communication difficulties to profound cognitive impairments.

"One of the challenges in autism is that we don't know how to classify patients into subgroups or even what those subgroups might be," said study leader Sophie Molholm, Ph.D., associate professor in the Dominick P. Purpura Department of Neuroscience and the Muriel and Harold Block Faculty Scholar in Mental Illness in the department of pediatrics at Einstein.

"This has greatly limited our understanding of the disorder and how to treat it."

Autism is diagnosed based on a patient's behavioural characteristics and symptoms.

"These assessments can be highly subjective and require a tremendous amount of clinical expertise," said Dr. Molholm. "We clearly need a more objective way to diagnose and classify this disorder."

An earlier study by Dr. Molholm and colleagues suggested that brainwave electroencephalogram (EEG) recordings could potentially reveal how severely ASD individuals are affected.

That study found that children with ASD process sensory information, such as sound, touch and vision, less rapidly than typically developing children do.

The current study was intended to see whether sensory processing varies along the autism spectrum. Forty-three ASD children aged 6 to 17 were presented with either a simple auditory tone, a visual image (red circle), or a tone combined with an image, and instructed to press a button as soon as possible after hearing the tone, seeing the image or seeing and hearing the two stimuli together.

Continuous EEG recordings were made via 70 scalp electrodes to determine how fast the children's brains were processing the stimuli.

The speed with which the subjects processed auditory signals strongly correlated with the severity of their symptoms: the more time required for an ASD individual to process the auditory signals, the more severe that person's autistic symptoms.

"This finding is in line with studies showing that, in people with ASD, the microarchitecture in the brain's auditory center differs from that of typically developing children," Dr. Molholm said.

The study also found a significant though weaker correlation between the speed of processing combined audio-visual signals and ASD severity. No link was observed between visual processing and ASD severity.

"This is a first step toward developing a biomarker of autism severity, an objective way to assess someone's place on the ASD spectrum," said Dr. Molholm.

"Using EEG recordings in this way might also prove useful for objectively evaluating the effectiveness of ASD therapies."

In addition, EEG recordings might help diagnose ASD earlier. "Early diagnosis allows for earlier treatment, which we know increases the likelihood of a better outcome," said Dr. Molholm.

"But currently, fewer than 15 percent of children with ASD are diagnosed before age 4. We might be able to adapt this technology to allow for early ASD detection and therapy for a much larger percentage of children."

More information: The paper is titled "Neurophysiological Indices of Atypical Auditory Processing and Multisensory Integration are Associated with Symptom Severity in Autism."

Saturday, September 20, 2014

US Congressional Committee Hearing on the Science of Dyslexia

In an age of gridlock and choking polarization, the yesterday’s Congressional Committee Hearing on the Science of Dyslexia evoked the best qualities of US governmental process: bringing elected officials to the table with ordinary citizens in non-partisan dialogue to solve a major societal problem.

For a two hours in Rayburn room 2318 on Capitol Hill, there were no Democrats or Republicans, just people concerned about the prevalence of dyslexia in our nation’s children and the fact that millions of families are struggling, and convinced that something huge needs to be done to help these kids read, learn and thrive.

What made the event most remarkable was its emotional richness. As data points from the vast body of dyslexia science were shared by leading experts, tears flowed and laughter filled the air.

At one point, Committee Chairman Lamar Smith of Texas commented that he’d never heard such eruptions of applause and enthusiasm in a Congressional Hearing.

Best of all, the event was made accessible for everyone: its live webcast was recorded and archived; and all of the testimony was transcribed.

Here are several highlights.

Clicking on the speakers’ names will bring up a full transcript of their remarks:

Rep. Bill Cassidy of Louisiana gave some of the day’s most compelling and heart-wrenching testimony, pausing several times to wipe away tears and collect himself.

“A couple of years ago, my youngest daughter was diagnosed with dyslexia. Prompted by concerns about my daughter and my constituents’ children, I set out to learn as much as I could about dyslexia and was amazed at how much is known and yet, far too often, not incorporated into public policy and education. . ."

"If dyslexia is identified in elementary school and the appropriate resources are given to these children, America can produce more teachers, more scientists and more entrepreneurs.”

Brownley1Rep. Julia Brownley of California also shared personal perspectives as a parent.

“When my daughter Hannah struggled to learn to read, like any parent I was completely panicked about what to do next."

"It was Hannah’s dyslexia, and learning to navigate the school system, where I witnessed the good, the bad, and the ugly, that led me to public service. . ."

"This spring, Hannah received her Master’s degree in International Studies, and is now overseas saving the world with a NGO in Kenya, Africa."

"She speaks three languages, and she still misspells in all of them! I could not be prouder of her. But for every success story like Hannah, there are countless others who do not succeed.”

Sally1Dr. Sally Shaywitz of the Yale Center for Dyslexia and Creativity made a passionate plea to policy makers that now is the time to translate science into action.

“In dyslexia, remarkably in America, in the year 2014, we have not a knowledge gap but an action gap."

"We have the knowledge but it is not being put into policy and practice and far too many children and adults, too, are suffering needlessly."

"There is an epidemic of reading failure that we have the scientific evidence to treat effectively and we are not acknowledging or implementing it. . ."

"I cannot look into the face of one more child who has lost faith in himself and the world, I cannot look into the face of a child’s father who is desperately trying to hold back tears; I cannot hear once again about how a school told a mother, ‘we do not believe in dyslexia.’. . ."

"It is our hope that hearing the depth and extent of the scientific knowledge of dyslexia will alert policy makers to act and to act with a sense of urgency. ”

Max Brooks, an accomplished author and screenwriter, electrified Committee members and the gallery crowd with his personal account of living with dyslexia:

“For me, dyslexia was nearly as bad as the feelings of anxiety, shame, and low self-esteem that it caused."

"For me, ‘learned dependency’ was the real enemy, the self-narrative that ‘I can’t do this’ that can destroy children’s learning potential for the rest of their lives."

"That was ALMOST me. I’ve spent the last 30 years unlearning the lesson that dyslexia taught me, that society has no use for me. . ."

“A little awareness and flexible teaching methods could unlock unlimited potential in these kids who now think they’re losers."

"If we already have mandatory racial sensitivity training for our police, why not have mandatory dyslexia recognition training for our teachers?"

"It’s so simple, so easy, and when you look at all the other government programs designed to help citizens help themselves, it’s probably the least expensive.”

Persusasive testimony was also given by panelists Stacy Antie, a mother and parent advocate; Paul Eden, president of Landmark College; and Guinevere Eden, Director of the Center for the Study of Learning (CSL) and Professor, Department of Pediatrics, Georgetown University Medical Center.

Later on in a Q&A session with Committee lawmakers, Max Brooks revived his comment about making dyslexia training “a mandatory part of every teacher’s certificate,” instantly sparking whoops of applause from the gallery crowd, including many members of the Decoding Dyslexia movement.

And those Decoding Dyslexia members, from states as nearby as Virginia, New Jersey and Pennsylvania, and from as far away as Texas, graciously gathered for a photo op of their own before the day’s proceedings concluded.

After the Committee Hearing, attendeees and panelists enjoyed a great luncheon hosted by the National Center for Learning Disabilities, featuring a preview look at the new Understood.org initiative and a website that will launch later this month.

This was followed by speeches by an assortment of guests, including Hal Malchow, President of the International Dyslexia Association, Robbi Cooper of Decoding Dyslexia Texas, and Kristin Kane of Decoding Dyslexia Virginia.

What will be the net impact of a day like this on our nation’s dyslexic children and the parents and teachers who support them?

It’s hard to say, but there was enough knowledge, passion and experience gathered there on Capitol Hill to move mountains.

With so many diverse players assembled at the table, it brought to life the vivid slogan Learning Ally has embraced this year: Together It’s Possible.

All credit goes to Learning Ally for the content of this article.

Friday, September 12, 2014

ADHD: Medication plus parent training may help kids with aggression

Combining two medications with parent training appears to improve anger, irritability and violent tendencies in children whose attention-deficit/hyperactivity disorder (ADHD) is coupled with severe aggression, a new study suggests.

"Augmented" therapy that consists of stimulant and antipsychotic drugs, along with parent training in behavioural management techniques, was rated more effective by parents than "basic" therapy pairing only the stimulant and parent training, researchers found.

"An important finding of this study was that at the end of nine weeks, approximately half of all children receiving basic therapy were still rated by their parents as being impaired... with symptoms interfering with school or social functioning," said study author Kenneth Gadow, a professor of psychiatry at Stony Brook University in New York.

"In the augmented group receiving three interventions for aggression, about one-quarter still, at the end of nine weeks, were rated by their parents as being impaired, and that suggests, even with highly effective therapies, that many of these children still have unmet treatment needs" " he added.

The drugs used in the study, published in the September issue of the Journal of the American Academy of Child and Adolescent Psychiatry, included the widely prescribed ADHD stimulant Concerta (methylphenidate) and the antipsychotic Risperdal (risperidone).

Approximately 11 percent of American children aged 4 to 17 have been diagnosed with ADHD, which includes symptoms such as impulsivity, hyperactivity, and difficulty focusing and controlling behavior, according to the U.S. Centers for Disease Control and Prevention.

As many as half of children with ADHD also display significant, disruptive aggression, according to an editorial accompanying the new research.

"This is very common among kids with ADHD, but unfortunately it complicates the picture for treatment," said Erin Schoenfelder, a clinical psychologist at Seattle Children's Hospital and assistant professor of psychiatry and behavioural health at University of Washington.

"It really is staggeringly high."

In the new research, Gadow and his colleagues divided a group of nearly 170 children aged 6 to 12 with ADHD and aggression problems into two treatment groups, basic and augmented.

The basic group received Concerta and their parents underwent behavioral management training.

The augmented group received Concerta and parental training as well, but also took the antipsychotic Risperdal. Both groups were followed for nine weeks.

While both groups of children displayed marked reduction in symptoms, improvement ratings varied depending on whether parents or teachers were making the assessment.

Parents reported that children on augmented therapy were less likely to be impaired socially or academically by their anger and irritability than children on basic therapy.

On the other hand, teachers found few differences in these measures.

Instead, teachers of those on augmented therapy reported significant drops in ADHD symptoms, especially impulsiveness, compared with teachers of children on basic therapy.

Gadow and Schoenfelder agreed that the conflicting parent-teacher ratings demonstrate a familiar concept: that children's behaviours vary in different settings, whether or not they have ADHD.

"Just like adults, they adapt their behaviours to be more appropriate for the setting they're in," Gadow said.

"People do differ, however, in their ability to modify their behaviour from one setting to the next, and some children are much more variable [in this regard]."

Schoenfelder said long-term evidence is needed indicating that combining Concerta and Risperdal is safe in children, but "it appears from this study that the combination was well-tolerated and something practitioners could [adjust the dosage of] effectively."

"Folks trying this type of treatment should have close monitoring," she added. "This is a starting point. It's a combination doctors may try when they see this blend of aggressive and hyperactive behaviours. It certainly will require adjustment . . . but it's exciting to find something helpful for a significant proportion of the kids studied."

The study authors pointed out that their findings only apply to children with ADHD who exhibit severe irritability and peer aggression.

They noted that the study's findings are not an indication of the ADHD population as a whole.

More Information: "Risperidone Added to Parent Training and Stimulant Medication: Effects on Attention-Deficit/Hyperactivity Disorder, Oppositional Defiant Disorder, Conduct Disorder, and Peer Aggression" http://www.jaacap.com/article/S0890-8567(14)00369-4/abstract

Thursday, August 21, 2014

Children with autism have extra synapses in brain

In a study of brains from children with autism, researchers found that autistic brains did not undergo normal pruning during childhood and adolescence. 

The images show representative neurons from autistic (left) and control (right) brains; the spines on the neurons indicate the location of synapses.

Credit: Guomei Tang, PhD and Mark S. Sonders, PhD/Columbia University Medical Center

Children and adolescents with autism have a surplus of synapses in the brain, and this excess is due to a slowdown in a normal brain "pruning" process during development, according to a study by neuroscientists at Columbia University Medical Center (CUMC).

Because synapses are the points where neurons connect and communicate with each other, the excessive synapses may have profound effects on how the brain functions.

The study was published in the August 21 online issue of the journal Neuron.

A drug that restores normal synaptic pruning can improve autistic-like behaviors in mice, the researchers found, even when the drug is given after the behaviours have appeared.

"This is an important finding that could lead to a novel and much-needed therapeutic strategy for autism," said Jeffrey Lieberman, MD, Lawrence C. Kolb Professor and Chair of Psychiatry at CUMC and director of New York State Psychiatric Institute, who was not involved in the study.

Although the drug, rapamycin, has side effects that may preclude its use in people with autism, "the fact that we can see changes in behaviour suggests that autism may still be treatable after a child is diagnosed, if we can find a better drug," said the study's senior investigator, David Sulzer, PhD, professor of neurobiology in the Departments of Psychiatry, Neurology, and Pharmacology at CUMC.

David Sulzer
During normal brain development, a burst of synapse formation occurs in infancy, particularly in the cortex, a region involved in autistic behaviours; pruning eliminates about half of these cortical synapses by late adolescence.

Synapses are known to be affected by many genes linked to autism, and some researchers have hypothesized that people with autism may have more synapses.

To test this hypothesis, co-author Guomei Tang, PhD, assistant professor of neurology at CUMC, examined brains from children with autism who had died from other causes.

Thirteen brains came from children ages two to 9, and thirteen brains came from children ages 13 to 20. Twenty-two brains from children without autism were also examined for comparison.

Dr. Tang measured synapse density in a small section of tissue in each brain by counting the number of tiny spines that branch from these cortical neurons; each spine connects with another neuron via a synapse.

By late childhood, she found, spine density had dropped by about half in the control brains, but by only 16 percent in the brains from autism patients.

"It's the first time that anyone has looked for, and seen, a lack of pruning during development of children with autism," Dr. Sulzer said, "although lower numbers of synapses in some brain areas have been detected in brains from older patients and in mice with autistic-like behaviours."


Clues to what caused the pruning defect were also found in the patients' brains; the autistic children's brain cells were filled with old and damaged parts and were very deficient in a degradation pathway known as "autophagy."

Cells use autophagy (a term from the Greek for self-eating) to degrade their own components. Using mouse models of autism, the researchers traced the pruning defect to a protein called mTOR.

When mTOR is overactive, they found, brain cells lose much of their "self-eating" ability and without this ability, the brains of the mice were pruned poorly and contained excess synapses.

"While people usually think of learning as requiring formation of new synapses, "Dr. Sulzer says, "the removal of inappropriate synapses may be just as important."

The researchers could restore normal autophagy and synaptic pruning, and reverse autistic-like behaviors in the mice, by administering rapamycin, a drug that inhibits mTOR.

The drug was effective even when administered to the mice after they developed the behaviors, suggesting that such an approach may be used to treat patients even after the disorder has been diagnosed.

Because large amounts of overactive mTOR were also found in almost all of the brains of the autism patients, the same processes may occur in children with autism.

"What's remarkable about the findings," said Dr. Sulzer, "is that hundreds of genes have been linked to autism, but almost all of our human subjects had overactive mTOR and decreased autophagy, and all appear to have a lack of normal synaptic pruning.

This says that many, perhaps the majority, of genes may converge onto this mTOR/autophagy pathway, the same way that many tributaries all lead into the Mississippi River.

Overactive mTOR and reduced autophagy, by blocking normal synaptic pruning that may underlie learning appropriate behaviour, may be a unifying feature of autism."

Alan Packer, PhD, senior scientist at the Simons Foundation, which funded the research, said the study is an important step forward in understanding what's happening in the brains of people with autism.

"The current view is that autism is heterogeneous, with potentially hundreds of genes that can contribute."

"That's a very wide spectrum, so the goal now is to understand how those hundreds of genes cluster together into a smaller number of pathways; that will give us better clues to potential treatments," he said.

"The mTOR pathway certainly looks like one of these pathways. It is possible that screening for mTOR and autophagic activity will provide a means to diagnose some features of autism, and normalizing these pathways might help to treat synaptic dysfunction and treat the disease."

Journal Reference: 
Guomei Tang, Kathryn Gudsnuk, Sheng-Han Kuo, Marisa L. Cotrina, Gorazd Rosoklija, Alexander Sosunov, Mark S. Sonders, Ellen Kanter, Candace Castagna, Ai Yamamoto, Zhenyu Yue, Ottavio Arancio, Bradley S. Peterson, Frances Champagne, Andrew J. Dwork, James Goldman, David Sulzer. "Loss of mTOR-Dependent Macroautophagy Causes Autistic-like Synaptic Pruning Deficits." Neuron, 2014; DOI: 10.1016/j.neuron.2014.07.040

ADHD children make poor decisions due to less differentiated learning processes

Attention-Deficit/Hyperactivity Disorder (ADHD) is one of the most common psychiatric disorders among school children. Pupils with ADHD often make poorer decisions than their unaffected classmates.

Researchers from the University of Zurich now discovered that different learning and decision-making mechanisms are responsible for these behaviors, and localized the underlying impairments in the brain.

Which shirt do we put on in the morning? Do we drive to work or take the train? From which takeaway joint do we want to buy lunch?

We make hundreds of different decisions every day. Even if these often only have a minimal impact, it is extremely important for our long-term personal development to make decisions that are as optimal as possible.

People with ADHD often find this difficult, however. They are known to make impulsive decisions, often choosing options which bring a prompt but smaller reward instead of making a choice that yields a greater reward later on down the line.

Researchers from the University Clinics for Child and Adolescent Psychiatry, University of Zurich, now reveal that different decision-making processes are responsible for such suboptimal choices and that these take place in the middle of the frontal lobe.

Mathematical models help to understand the decision-making processes
In the study, the decision-making processes in 40 young people with and without ADHD were examined.

Lying in a functional magnetic resonance imaging (fMRI) scanner to record the brain activity, the participants played a game where they had to learn which of two images carried more frequent rewards.

To understand the impaired mechanisms of participants with ADHD better, learning algorithms which originally stemmed from the field of artificial intelligence were used to evaluate the data.

These mathematical models help to understand the precise learning and decision-making mechanisms better.

"We were able to demonstrate that young people with ADHD do not inherently have difficulties in learning new information; instead, they evidently use less differentiated learning patterns, which is presumably why sub-optimal decisions are often made", says first author Tobias Hauser.

Multimodal imaging affords glimpses inside the brain
To study the brain processes that triggered these impairments, the authors used multimodal imaging methods, where the participants were examined using a combined measurement of functional magnetic resonance imaging (fMRI) and electroencephalography (EEG) to record the electrical activity and the blood flow in the brain.

It became apparent that participants with ADHD exhibit an altered functioning in the medial prefrontal cortex, a region in the middle of the frontal lobe.

This part of the brain is heavily involved in decision-making processes, especially if you have to choose between several options, and in learning from errors.

Although a change in activity in this region was already discovered in other contexts for ADHD, the Zurich researchers were now also able to pinpoint the precise moment of this impairment, which already occurred less than half a second after a feedback, i.e. at a very early stage.

Psychologist Tobias Hauser, who is now researching at the Wellcome Trust Centre for Neuroimaging, University College London, is convinced that the results fundamentally improve our understanding of the mechanisms of impaired decision-making behaviour in people with ADHD.

The next step will be to study the brain messenger substances. "If our findings are confirmed, they will provide key clues as to how we might be able to design therapeutic interventions in future," explains Hauser.

More information: Tobias U. Hauser, Reto Iannaccone, Juliane Ball, Christoph Mathys, Daniel Brandeis, Susanne Walitza & Silvia Brem: Role of Medial Prefrontal "Cortex in Impaired Decision Making in Juvenile Attention-Deficit/Hyperactivity Disorder," in: JAMA Psychiatry, DOI: 10.1001/jamapsychiatry.2014.1093

Wednesday, August 20, 2014

Autism: ASU experts follow gut reaction in digestion treatment study

Clostridium difficile in the gut. The overgrowth of this dangerous bacteria can cause serious, life-threatening infections. 

About half of all children and adults with autism suffer from chronic gastrointestinal problems, causing frequent pain, discomfort and irritability.

Research out of Arizona State University suggests these gastrointestinal (GI) complications may be due, in part, to abnormal gut bacteria.

A new study approved by the U.S. Food and Drug Administration and led by Arizona State University will examine a novel treatment, called fecal microbiota transplant (FMT), for GI problems in children with autism.

The treatment involves transferring about 1,000 different species of live gut bacteria from a healthy donor that then act like a broad-spectrum probiotic treatment to restore normal gut bacteria.

FMT has been used to treat serious Clostrium difficle infections that kill up to 15,000 people each year in the United States.

Determining the safety and tolerability of using FMT to treat GI problems in children with autism is driving the study.

The FDA has approved a pilot treatment study of 20 children with autism, ages 7 to 17 years, and moderate to severe gastrointestinal problems.

Missing bacteria
Led by professor Rosa Krajmalnik-Brown, an expert on evaluating the composition of gut bacterial communities, and professor James Adams, director of the ASU Autism/Asperger's Research Program, the ASU research team published a scientific paper last year demonstrating that children with autism were missing several hundred species of gut bacteria compared to typical children.

"Our initial work found major differences in the gut bacteria of children with autism compared to typical children, and our subsequent work has confirmed those findings," said Krajmalnik-Brown.

"Children with autism seem to be missing hundreds of beneficial gut bacteria."

"Many children and adults with autism have chronic gut problems, sometimes lasting for many years and seriously affecting their quality of life," said Adams. "We think this treatment may be helpful."

The team's hypothesis is that FMT will "reseed" the gut with beneficial bacteria that will help diminish GI problems and possibly reduce autistic symptoms.

Several studies show that FMT may also be helpful in treating other GI problems, such as ulcerative colitis, Crohn's disease, inflammatory bowel disease, irritable bowel syndrome and chronic constipation.

Beneficial versus harmful
The human gut typically contains more than 1,000 different species of bacteria – most of them beneficial.

These bacteria help with digesting food, making certain vitamins, improving GI function and protecting against pathogenic bacteria.

However, there are a few dangerous bacteria, such as Clostidium difficile (C. difficile), which can cause serious, life-threatening infections.

C. difficile kills about 15,000 people per year in the U.S., but a single dose of FMT has been shown to cure C. difficile with 92 percent effectiveness, usually within a few days.

Collaborating with Northern Arizona University and University of Arizona, the ASU team will lead the treatment portion of the study, with the help of Sharon McDonough-Means, a developmental pediatrician involved in the care of children with autism and previous research studies.

Greg Caporaso at NAU, an expert in computational and statistical methods for studying communities of microorganisms, will analyze the effect of FMT on gut bacterial communities, and Matthew Sullivan at UA will investigate the viruses that infect gut bacteria, and thereby affect bacterial populations in the gut.

The new initiative is a follow-up to a previous study that demonstrated that treatment with a powerful oral antibiotic, vancomycin, led to a temporary improvement in both gut symptoms and symptoms of autism, presumably because it killed off harmful bacteria in the gut.

However, when the treatment was stopped, the benefits were lost, presumably because there was insufficient "reseeding" of the gut with beneficial bacteria.

Monday, August 18, 2014

The boundaries of reading apps for children

A series of binary discussions has been plaguing early reading instruction for quite some time now: phonics versus whole language, reading for pleasure versus reading for learning, digital versus paper books and it seems that there is a new tug-of-war on the educational horizon: spritzing versus slow reading.

Spritz is a recently developed programme that brings speed-reading to the untrained eye. Its makers claim that users can ultimately read 1,000 words per minute.

Their goal is to have 15% of the world's texts available in Spritz format by 2016.

But a message is coming from the other direction too. Those who revere and often romanticise printed books argue that we need to slow down.

They warn that the digital age has made us shallow readers who flit from text to text without taking anything in.

We have a clear conflict here. On one hand, lots of people want to read faster, especially now that there is more to read out there than at any other time in human history.

On the other hand, we hear that children in the digital age do not read in depth and the often cited culprit is the device in their hand – the technology that distracts them from picking up a good book.

Is a middle ground possible?

Reading and writing always come hand-in-hand. If readers whizz through rather than engage with texts, this will ultimately be reflected in the type of texts made available to them.

Spritz certainly responds to the zeitgeist to read fast in order to cope in a text-saturated era. You can also see this tendency in the proliferation of listicles on news websites and contents pages that tell you how long it will take you to read an article.

Some say that the only way to cope with large email volumes, is to binge-read our inboxes. Spritz could be thus seen as another invention that panders to our growing tendency to read more but in less depth.

At the same time, readers, be they young or old,need to be given time to pause and think with the author of a text.

Slow reading is, for many, synonymous with deep reading and reading for learning and there are in fact technological developments happening to help readers improve their deep reading, almost the antidote to Spritz.

There are reading annotation systems with built-in interactive discussion to help readers, students in particular, to better understand what they are reading.

These slow them down in their reading by asking them questions or prompting them to pause and take notes.

Similarly for younger readers, there are read-to-learn apps that explain vocabulary and thus help with reading comprehension.

So which approach is better for the contemporary reader? We can now whizz through every page on the internet by installing Spritzlet on our web browser.

It may not be long until slow reading widgets will become available to help us highlight information in onscreen texts, underline unfamiliar words, unpick abstract metaphors and provide links to facts.

In thinking about how to teach children to read effectively in digital age, we need to stop thinking in terms of slow and fast.

There is a difference between reading an email or a chemistry textbook or a novel. We use different reading formats for different contents, and different contents & formats for different purposes.

These different purposes come with different personal investments and hence different reading techniques.

There is already a disturbing disconnect between the content and format of reading happening in schools and outside the classrooms. Let's not increase this gap with another fictitious dichotomy.

Tuesday, August 5, 2014

Children with Autism: Blood-oxytocin levels in normal range

Spacefilling model of oxytocin. Created using ACD/ChemSketch 8.0, ACD/3D Viewer and The GIMP. 

Credit: Wikipedia.

Autism does not appear to be solely caused by a deficiency of oxytocin, but the hormone's universal ability to boost social function may prove useful in treating a subset of children with the developmental disorder, according to new findings from the Stanford University School of Medicine and Lucile Packard Children's Hospital Stanford.

Low levels of oxytocin, a hormone involved in social functioning, have for years been suspected of causing autism. Prior research seeking a link has produced mixed results.

Now, in the largest-ever study to test the purported connection, the range of blood oxytocin levels has been shown to be the same in children with autism as that observed in two comparison groups: children with autistic siblings and children without autistic siblings.

In other words, similar numbers of children with low, medium and high oxytocin levels were found in all three groups.

A paper describing the new findings will be published online Aug. 4 in Proceedings of the National Academy of Sciences (PNAS).

Although autism was not directly linked to oxytocin deficiency, the Stanford team found that higher oxytocin levels were linked to better social functioning in all groups.

All children with autism have social deficits, but in the study these deficits were worst in those with the lowest blood oxytocin and mildest in those with the highest oxytocin.

In the comparison groups, children's social skills also fell across a range that correlated to their oxytocin levels.

"Oxytocin appears to be a universal regulator of social functioning in humans," said Karen Parker, PhD, assistant professor of psychiatry and behavioural sciences and the lead author of the study.

"That encompasses both typically developing children as well as those with the severe social deficits we see in children with autism."

Autism is a developmental disorder that affects 1 of every 68 children in the United States. It is characterised by social and communication deficits, repetitive behaviours and sensory problems.

The new study included 79 children with autism, 52 of their unaffected siblings and 62 unrelated children without autism. All of the children were between the ages of 3 and 12.

"It didn't matter if you were a typically developing child, a sibling or an individual with autism: Your social ability was related to a certain extent to your oxytocin levels, which is very different from what people have speculated," said Antonio Hardan, MD, professor of psychiatry and behavioural sciences and the study's senior author.

Hardan is a child and adolescent psychiatrist who treats children with autism at the hospital.

"The previous hypotheses saying that low oxytocin was linked to autism were maybe a little bit simplistic," he said.

"It's much more complex: Oxytocin is a vulnerability factor that has to be accounted for, but it's not the only thing leading to the development of autism."

The researchers caution, however, that blood oxytocin measurements may be different than oxytocin levels in the cerebrospinal fluid bathing the brain, which they did not measure.

In addition to examining blood oxytocin levels, the researchers examined the importance of small variations in the gene coding for the oxytocin receptor.

Certain receptor variants were correlated to higher scores on standard tests of social ability, the study found.

The team also discovered that blood levels of oxytocin are highly heritable: The levels are influenced by inheritance to about the same degree as adult height, which is often described as being strongly influenced by genetics.

"What our study hints at is that social function may be heritable in families," Parker said.

The study will help to guide future research to determine whether oxytocin is a useful autism treatment.

The study's findings suggest that some children with autism, such as the subset of kids with autism who have naturally low oxytocin levels, or those with oxytocin receptor gene variants associated with worse social functioning, might benefit most from oxytocin-like drugs.

"Autism is so heterogeneous," Parker said. "If we can identify biomarkers that help us identify the patients most likely to benefit from a specific therapy, we expect that will be very useful."

More information: "Plasma oxytocin concentrations and OXTR polymorphisms predict social impairments in children with and without autism spectrum disorder," by Karen J. Parker et al. PNAS, www.pnas.org/cgi/doi/10.1073/pnas.1402236111